What Is Acid Reflux?
Food travels through the esophagus towards the stomach. At its very end, esophagus is narrowed due to a sphincter (concentric muscle) located in its wall. This muscle is supposed to prevent food from coming out of the stomach and returning to the esophagus. When the sphincter becomes weaker than usual, it allows a reflux of stomach content back into the esophagus, producing the symptoms of gastroesophageal reflux disease (GERD). This happens because of the differences in constitution of the esophageal and stomach mucosa. Namely, esophageal mucosa are much more sensitive to acids, and acid reflux can lead to damage.
What Causes Acid Reflux?
An inborn susceptibility to weakening of the sphincter with age is one of the causes that cannot be controlled. On the other hand, modifiable risk factors include:
- Lying down after eating
- Late night eating
- Spicy food
- Drinking a lot of coffee
- Certain drugs (aspirin and NSAIDs).
Some of these factors increase the acidity of your stomach content (coffee, drugs), while the others increase abdominal pressure, thus pushing the stomach content upwards, back into the esophagus.
The main symptom of GERD is heartburn (pyrosis), which is a burning pain in the upper abdomen or in the chest. Sometimes, it can be felt even in the throat. This pain can often be misunderstood as cardiac pain, especially in patients with existing heart conditions (angina pectoris). Some other symptoms include excessive burping, bloating, nausea, and vomiting. If food intake becomes difficult because of the narrowing of the above mentioned sphincter, a person can lose weight overtime. Chronic sore throat and bad breath can be felt because of the returned stomach content.
The diagnosis is made by barium contrast radiography, esophageal pH monitoring, and other techniques, but an endoscopy with biopsy of noticed changes represents a gold standard. An endoscopy implies swallowing an endoscopic tube a with camera on its top, which is then led through the esophagus to the junction with stomach, so the changes can be visualized.
Lifestyle changes are the first step in the successful treatment of GERD. It is recommended to eat smaller portions of food several times a day instead of overeating twice or three times a day. Smoking needs to be removed as a proven risk factor. You should not be eating at least two hours before lying down, and avoid wearing clothes that put high pressure on your abdomen (e.g. tight belts). Increase your level of physical activity, especially if you are obese.
Medication treatment includes drugs which lower the acidity of the stomach content (antacids), but they usually do not help in severe cases. H2 blockers are used in moderately severe cases and they act by blocking histamine receptors in the stomach, thus preventing acid production. Inhibitors of proton pump (H+ blockers) are another group of drugs aimed for the same purpose, but more potent than H2 blockers. All these medications should be prescribed by your physician after detailed examination.
Surgical treatment is reserved for the most severe cases, and it includes a procedure called fundoplication. A part of the stomach (fundus) is attached to the ending part of the esophagus, thus creating a valve which prevents the stomach content to return to the esophagus. Novel approaches include LINX device placement around the ending part of the esophagus, which uses concentric distribution of magnets in order to narrow the entrance into the stomach and prevent acid reflux.
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